Cre­ativ­ity plays role in adapt­ing fa­cil­i­ties to new health­care land­scape

Fa­cil­i­ties can play ma­jor role in adapt­ing to new health­care land­scape

Modern Healthcare - - NEWS - Dou­glas Childs, left, is a prin­ci­pal with TAY­LOR, a de­sign firm whose mis­sion is “Pro­mot­ing Well­ness through Ar­chi­tec­ture.” Ray­mond Hino is the act­ing CEO of Bear Val­ley (Calif.) Com­mu­nity Health­care District.

Health­care lead­ers in the midst of chang­ing their busi­ness models to adapt to the Pa­tient Pro­tec­tion and Af­ford­able Care Act should con­sider the role that plan­ning and de­sign­ing fa­cil­i­ties plays in ad­dress­ing the chal­lenges of a chang­ing in­dus­try.

Cre­ativ­ity, in­no­va­tion and “new school” think­ing, es­pe­cially given the grow­ing push to­ward am­bu­la­tory-care fa­cil­i­ties, can make a big dif­fer­ence.

De­ci­sions made in the plan­ning, de­sign and build­ing of health­care fa­cil­i­ties must re­flect the new land­scape spurred by re­form and other in­ter­nal and ex­ter­nal forces. Cir­cum­stances de­mand sub­stan­tive changes and bold ideas, not su­per­fi­cial win­dow dress­ing sold as some­thing dif­fer­ent and new.

What do fa­cil­i­ties need to­day and what will they need to­mor­row to de­liver the best pos­si­ble pa­tient and staff ex­pe­ri­ence? What will the health­care fa­cil­ity of the fu­ture look like?

The trend is de­cid­edly to­ward “pa­tient-cen­tric” care, which means fa­cil­i­ties must be where the pa­tients need them to be. And they need to be de­signed with the pa­tient ex­pe­ri­ence in mind, not just the con­ve­nience of the care teams.

More choices must be made avail­able to health­care con­sumers. The most re­spon­sive fa­cil­i­ties will gar­ner the most and best busi­ness.

Health­care fa­cil­i­ties of the fu­ture need to ac­com­mo­date the ris­ing de­mand for pri­mary care. They should pro­vide out­pa­tient care set­tings that achieve economies of scale, pro­mote col­lab­o­ra­tion and of­fer “one-stop shop­ping.”

In ad­di­tion to exam and treat­ment spa­ces, com­po­nents should in­clude space for pa­tient ed­u­ca­tion in preven­tion, fit­ness and health main­te­nance. Rooms for coun­sel­ing ser­vices also need to be part of the mix.

Cur­rent clinic lay­outs un­der­score the prob­lems with many fa­cil­ity de­signs. Physi­cians typ­i­cally work in pri­vate of­fices, sep­a­rated from the rest of the staff. As a re­sult, face-to-face com­mu­ni­ca­tion with co-work­ers is lim­ited, which un­der­mines col­lab­o­ra­tive care.

Exam rooms are also a prob­lem. They tend to be small—typ­i­cally about 90 square feet—with lim­ited space for care­givers and staff. They are usu­ally in­flex­i­ble with lit­tle po­ten­tial to vary their use when new care models come along.

In­ef­fi­cient over­all de­sign is a an­other draw­back of to­day’s tra­di­tional out­pa­tient clinic. Large wait­ing spa­ces con­trib­ute to pa­tient

What will the health­care fa­cil­ity of the fu­ture look like?

de­lays. Ef­fec­tive pa­tient flow and op­er­a­tional ef­fi­cien­cies are of­ten an af­ter­thought.

Good de­sign can pro­mote col­lab­o­ra­tion among clin­i­cians, max­i­mize cross-re­fer­rals by co-lo­cat­ing ser­vices and build flex­i­bil­ity into the fa­cil­ity with­out break­ing the bank. Fa­cil­ity plan­ners can start by set­ting three goals for the de­sign of an am­bu­la­tory-care fa­cil­ity.

First, stream­line front-end op­er­a­tions and re-imag­ine how care will be de­liv­ered. This means tak­ing steps to im­prove the pa­tient ar­rival and reg­is­tra­tion process; us­ing tech­nol­ogy to ac­cel­er­ate the pa­tient visit process; and re­struc­tur­ing the pa­tient room­ing sys­tem to im­prove ef­fi­ciency. Also, in­te­grate elec­tronic health records with care pro­cesses to max­i­mize the use of care­giver time.

Sec­ond, en­hance clinic de­sign by map­ping cur­rent and fu­ture work­flow, op­ti­miz­ing value for pa­tients and staff, cre­at­ing shared workspaces that en­cour­age staff/clin­i­cian com­mu­ni­ca­tion, and look­ing at care pro­cesses from the pa­tients’ per­spec­tive. This may in­clude re­mov­ing physi­cians’ pri­vate of­fices, cre­at­ing more stan­dard­ized workspaces and standup work ar­eas, and ex­am­in­ing new staffing models to lever­age physi­cian ex­per­tise.

Third, cre­ate ex­am­i­na­tion rooms with suf­fi­cient size and a flex­i­ble lay­out to en­sure high- qual­ity care de­liv­ery and full involvement of pa­tients, fam­ily and care­givers. Too of­ten, spa­ces and exam rooms are de­signed to sat­isfy the re­quests of the se­nior physi­cian (who might re­tire within a year of the project open­ing).

The project team can help achieve th­ese ben­e­fits through the de­sign process by:

In­clud­ing more of the “peo­ple do­ing the work” in the plan­ning process, not just se­nior staff.

In­te­grat­ing “Lean” think­ing into the plan­ning process. If done cor­rectly, this will re­duce waste in care pro­cesses (and there­fore im­prove ef­fi­ciency).

In­cor­po­rat­ing 3D com­puter sim­u­la­tion mod­el­ing to test work­flow and staff as­sump­tions to il­lus­trate how the new space will look and feel.

Tak­ing a more ag­gres­sive ap­proach to stan­dard­iza­tion for work pro­cesses.

Uti­liz­ing com­po­nent con­struc­tion and avoid­ing “one-off” project think­ing.

To en­sure that th­ese de­sign im­prove­ments oc­cur, health­care ex­ec­u­tives and plan­ners need to hold the de­sign and con­struc­tion in­dus­try ac­count­able. They must in­sist that de­sign de­ci­sions are driven not by what has been done in the past, but by what con­trib­utes best and most ef­fi­ciently to the abil­ity to care for pa­tients, now and in the fu­ture. This also ap­plies to those on the owner’s side who are in­volved in fa­cil­ity plan­ning and de­sign.

The health­care fa­cil­ity of the fu­ture needs de­ci­sive lead­er­ship, not a wait-and-see ap­proach or re­liance on past prac­tices that are quickly be­com­ing ob­so­lete. We need to look for­ward, think cre­atively and take a fresh ap­proach to our fa­cil­ity de­sign if we’re go­ing to con­tinue de­liv­er­ing the best pa­tient care pos­si­ble.

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